Department of Internal Medicine B, Sanz Medical Center, Netanya, Israel.
Ruth and Bruce Rappaport School of Medicine, Haifa, Israel.
Expert Rev Anti Infect Ther. 2020 May;18(5):453-460. doi: 10.1080/14787210.2020.1746642. Epub 2020 Mar 26.
: It is unclear how to prevent the negative impact of inappropriate urine cultures in older acute care patients who have a high rate of asymptomatic bacteriuria.: A nonsystematic literature review of the definition, impact, and management of elderly acute care patients with asymptomatic bacteriuria (ASB).: In the elderly, patients with ASB include those with extra-urinary tract diseases (e.g. pneumonia) and those with symptoms/signs that resolve without antibiotic therapy, but the diagnosis of ASB is unclear in febrile patients responding to antibiotics. We consider four management strategies that could decrease the negative impact of culturing the urine including unnecessary antibiotic therapy in those with ASB: (1) Prevent urine testing in patients with extra-urinary tract reasons for their acute care (2) Cancel urine cultures if the urine dipstick is negative. (3) Avoid catheterization in stable patients who cannot provide a urine specimen on demand and (4) Withhold antibiotics in stable non-febrile elderly patients who do not have new local urinary tract symptoms or decompensation on follow-up, and pursue further investigations for another etiology/diagnosis.
如何预防在急性护理的老年患者中，因无症状性菌尿而产生负面影响，目前尚不清楚。对老年急性护理患者无症状性菌尿（ASB）的定义、影响和管理进行非系统性文献复习。在老年人中，ASB 患者包括有尿路外疾病（如肺炎）的患者和那些症状/体征在无需抗生素治疗时即可缓解的患者，但在发热患者对抗生素有反应时，ASB 的诊断并不明确。我们考虑了四种管理策略，可以减少培养尿液对患者的负面影响，包括对患有 ASB 的患者避免不必要的抗生素治疗：（1）对因尿路外原因接受急性护理的患者预防尿液检测；（2）如果尿液干化学试带检查为阴性，则取消尿液培养；（3）避免对不能按需提供尿液标本的稳定患者进行导尿；（4）对稳定且不发热的无新局部尿路症状或在随访中无失代偿的老年患者，停用抗生素，并对其他病因/诊断进行进一步调查。
